A Brief History of Acupuncture and Chinese Medicine

A cross tattooed on Ötzi's knee

The earliest evidence of acupuncture comes from a stone age man found preserved in the Alps. "Ötzi the Iceman", dating to 5200 years ago, demonstrates a collection of tattoos, some of which do not appear to be decorative and are on classical acupuncture points for lumbar pain where radiological studies have confirmed he suffered arthritis. It is circumstantial evidence but several other mummies from as far as Siberia and Peru have shown similar markings along with other figurative tattoos that imply these crosses and dots have a separate purpose to the decorative ones.

Some time around 400-100BC, a book appears in China called the Huangdi Neijing, or "Yellow Emperor's Inner Classic", which departs from previous shamanic belief about evil spirits causing disease and instead proposes imbalance in lifestyle, diet, emotions and environment as causing similar imbalances to health in man. Acupuncture was one of the main methods described to correct imbalances and prevent disease. Partly a collection of medical texts and partly a meditation on man's relationship with the universe, its contents are often cryptic, contradictory and still debated to this day. A few centuries later, around 200AD two more works, the Shennong Bencao, or "Divine Farmer's Materia Medica", and the Shanghan Zabing Lung, "Treatise on Cold Damage and Miscellaneous Diseases", laid the foundations for herbal medicines.

Emperor Huangdi

European chart of piercing points, 1528

In Europe similar systems of piercing and herbal remedies were developed, often with the points in much the same place for similar disorders and even the diagnostic language and tools bearing remarkable similarity. The main difference was that western philosophy focused on matter meaning that piercing became largely aimed at letting blood to release harmful homours. Despite the mechanisms proposed for bloodletting being disproved by William Harvey as early as 1628 its use continued until the end of the 19th century and was even praised as the first among therapeutic remedies because doctors believed it worked even if the reasons were yet to be understood. As science discovered active ingredients in plants, herbal medicine also lost its complex formulas and started to focus on single herbs and isolated extracts for specific diseases.

By contrast Chinese culture focused on gradual cultivation of subtle changes and a concern for depletion which led to attempts to avoid harm to the body. This led to a medical system that valued sensations and functional improvements over the volume of blood which was reduced to minimal. Various schools of medicine developed mainly focused around herbal formulae while the popularity of acupuncture waxed and waned through the centuries until it was almost eradicated after the introduction of western medicine to China. Fascinated by the dramatic results of western medicine in epidemic diseases, something China had always struggled with, the new communist regime tried to eliminate traditional practices in the drive for a modern country following the rational materialist philosophies of communism and science.

Modernisation does not come instantly or without its problems. Folk medicine had continued to be popular despite its ban, especially in rural areas where hospital care was often unavailable. In the 1950s China decided to embrace its ancient culture once again and revived the traditional medical system as part of its cultural revolution. They brought scholars together to develop an official system, stripped of the spiritual background and condensed into the major principles which became known as the "Old Medicine" or "Traditional Medicine". With government backing new life came to acupuncture with fine needles developed that eliminated the need for bleeding entirely but at the expense of ideas that fell outside of the government's program being censored. It was brought back into hospitals and the mainstream medical system in China so that all doctors had some training in its use and specialists in particular fields developed.

TCM Shop in China

Acupuncture arrived in the west in several stages. As early as 1683 the Dutch doctor Willem ten Rhijne had written the first detailed study on acupuncture but its incompatibility with western models of anatomy meant that it never fully caught on. Some physicians had flirted with pulse diagnosis ever since contact with China and acupuncture had a period of popularity among physicians in the 19th century but the challenges of understanding its mechanisms meant new advances were hard to make and as publications dwindled so did practice amongst western physicians.

Five Phases, made popular by Worsley

The first method to gain popular acceptance in England was the Five Element style taught by J.R. Worsley in the 1950s based on a selection of classical ideas and given a "new age" focus on psychology and spirituality. It was quite different to anything practised in China but resonated with western audiences and flourished in the therapeutic market of the 1960s. When an aide to Richard Nixon received acupuncture during a state visit to China in the 1970s a wave of mainstream popularity brought the practice to scientific attention. Westerners travelled to China to learn from Chinese masters and various books were published in English that coined the term "Traditional Chinese Medicine" (TCM). Some of these became so popular that they began to influence teaching in China and courses in "TCM" appeared on the Chinese curriculum in the 1980s. Other attempts were made to develop a western medical acupuncture that explained its mechanisms in entirely physiological terms. Since then it has enjoyed a revival around the world with a lively debate about its mechanisms and potential along with expositions from historians on the meanings of the ancient texts and recipients of oral traditions revealing practices thought lost to the cultural revolution.

Chinese herbal medicine has been slower to gain acceptance in the west. This is partly due to having our own tradition and partly due to controversies over identification of correct species, toxicity, the use of animal parts and the inclusion of drugs in imported herbal products from China where the two are not so clearly separated. This has caused numerous laws to be employed in Europe which have seen whole categories of medicinals removed instead of the profession recognised, researched and regulated. However the contribution of Chinese herbs to western medicine has been undeniable with the Nobel Prize for Medicine in 2015 going to Tu Youyou for her research into Artemesinin, a treatment for malaria discovered in the works of a 3rd century alchemist. This plant, often in its natural form, is now a front line defence in the battle against this deadly disease. Academia is also becoming more interested in finding models to understand the actions of whole herbs and complex formulas which may be able to target multiple mechanisms at once. Meanwhile the use of Chinese herbs amongst the general western population has increased as an interest in natural alternatives or complements to drug regimes has developed. Despite the challenges to their profession Chinese herbalists are often sought for their knowledge of a wide range of species and the art of formula construction.

Tu Youyou,Nobel Prize Winner for Medicine, 2015

For those interested in learning more I recommend:
Barnes, L.L. (1998): The Psychologizing of Chinese Medicine in the United States in Culture, Medicine and Psychiatry 22(4), 413-43.
Barnes, L.L. (2005): Needles, Herbs, Gods and Ghosts: China Healing and the West to 1848. Harvard University Press.
Dorfer, L., Moser, M., Bahr, F., Spindler, K., Egarter-Bigl, R., Guillen S., Dohr, G. and Kenner, G. (1999): A Medical Report from the Stone Age? in The Lancet 354(9183), 1023–1025.
Buck, C. (2014): Acupuncture and Chinese Medicine: Roots of Modern Practice. Singing Dragon.
Kuriyama, S. (2002): The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine. Zone Books.
Taylor, K. (2004): Divergent Interests and Cultivated Misunderstandings: The Influence of the West on Modern Chinese Medicine in Social History of Medicine 17(1), 93-111.
Tu, Y. (2011): The discovery of artemisinin (qinghaosu) and gifts from Chinese medicine in Nature 17, 1217–1220.
Unschuld, P. (2010): Medicine in China: A History of Ideas. University of California Press.